Circulating tumor cells are associated with poor outcomes in early-stage hepatocellular carcinoma: a prospective study

Yeonjung Ha, Tae Hun Kim, Jae Eul Shim, Sunghyun Yoon, Mi Jung Jun, Young Ho Cho, Han Chu Lee

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23 Scopus citations


Background: Previous studies evaluating association between circulating tumor cells (CTCs) and clinical outcomes in hepatocellular carcinoma (HCC) have shown inconsistent results due to suboptimal detection methods and patient heterogeneity. Methods: Patients undergoing surgery for early-stage HCC were prospectively enrolled. The CTC numbers were determined using a tapered slit platform, which detects CTCs based on the cell size and morphology. Survival and recurrence were evaluated, and Cox proportional hazards models were used to demonstrate the prognostic significance of CTC. Results: Of 105 patients, 25 had increased CTC numbers after surgery (ΔCTC > 0, defined as positive) and a significantly higher level of recurrence (p = 0.042). A positive ΔCTC was seen to be an independent predictor of recurrence (hazard ratio 2.28), along with hepatitis B virus infection, alanine aminotransferase level, and the presence of satellite nodules (all p < 0.05). Subgroup analyses showed that a positive ΔCTC was associated with lower survival and higher recurrence among patients with low alpha-fetoprotein levels and cirrhosis (all p < 0.05). Conclusion: Calculation of ΔCTC based on the physical properties of the cells is predictive of recurrence in patients with early HCC undergoing surgery.

Original languageEnglish
Pages (from-to)726-735
Number of pages10
JournalHepatology International
Issue number6
StatePublished - 1 Nov 2019

Bibliographical note

Funding Information:
This work was supported in full by the Fundamental R&D Programs for Core Technology of Materials, Ministry of Trade, Industry and Energy (Grant Number: 10078295). The funder had no role in study design, data collection, analysis, and interpretation, writing of the report, or decision to submit the article for publication.

Publisher Copyright:
© 2019, Asian Pacific Association for the Study of the Liver.


  • Circulating tumor cells
  • Hepatocellular carcinoma
  • Nanomedicine
  • Recurrence
  • Survival


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